Low dose concomitant treatment with chlorpromazine and promethazine is safe in acute ischemic stroke.
Low dose concomitant treatment with chlorpromazine and promethazine is safe in acute ischemic stroke.
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DOI：
10.23736/s0390-5616.19.04665-4
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发表时间：
2019-06
影响因子：
1.9
通讯作者：
Haomeng Zhu;Ankush Chandra;Xiaokun Geng;Zhe Cheng;Yanna Tong;Huishan Du;Yuchuan Ding
中科院分区：
文献类型：
--
作者：
Haomeng Zhu;Ankush Chandra;Xiaokun Geng;Zhe Cheng;Yanna Tong;Huishan Du;Yuchuan Ding
急性缺血性卒中（AIS）与显著的发病率和死亡率相关，并且使用纤溶药物的治疗窗口非常窄。我们研究了氯丙嗪和异丙嗪联合治疗AIS的安全性和有效性。方法选择64例确诊为AIS的连续患者，随机（双盲）分为对照组（标准治疗[SOC]治疗）或治疗组（SOC+C+P [12.5+12.5 mg BID或25+25 mg BID]），治疗2周。治疗前后采用美国国立卫生研究院卒中量表（NIHSS）和改良兰金量表（mRS）评定神经功能缺损程度和日常功能状态。结果：64例患者（男性=81.3%）分为对照组（34例，男性83.3%，平均年龄=58.8±11.7岁）和研究组（30例，男性79.4%，平均年龄=62.3±9.1岁）。虽然入院时对照组和治疗组之间的NIHSS评分无差异（P>0.05），但两组队列中NIHSS评分较低的患者比例更高（对照组NIHSS评分较低= 79.4%，NIHSS评分较高= 20.6%，P 0.05），表明C+ P治疗的获益未改善。此外，与治疗组相比，使用C+P治疗未导致任何严重不良反应。结论：虽然在急性缺血性卒中的标准治疗中加入低剂量氯丙嗪和异丙嗪对功能结局没有任何显著改善，但也没有严重的不良反应。因此，在急性缺血性卒中中使用氯丙嗪和异丙嗪以及未来使用更高剂量C+P的研究是合理的。
BACKGROUND Acute ischemic stroke (AIS) is associated with significant morbidity and mortality and has a very narrow window of treatment with fibrinolytics. We investigated the safety and efficacy of combined chlorpromazine and promethazine (C+P) treatment in AIS. METHODS A total of 64 consecutive patients diagnosed with AIS were selected and were randomly (double-blind) assigned into either the control group (standard of care [SOC] treatment) or the treatment group (SOC+C+P [12.5+12.5 mg BID or 25+25 mg BID]) which were treated for 2 weeks. The National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were computed prior to and after treatment to evaluate neurological deficits and daily functional status. RESULTS In our study, 64 patients (males=81.3%) were divided into either the control (34 patients, 83.3% males, mean age=58.8±11.7 years) or the study group (30 patients, 79.4% males, mean age=62.3±9.1 years). While the NIHSS scores were not different between the control and treatment group at admission (P>0.05), a greater proportion of the cohort in both the groups (control group low NIHSS=79.4%, high NIHSS=20.6%, P0.05) suggesting no improved benefit with C+P. Moreover, using C+P did not lead to any serious adverse effects when compared to the treatment group. CONCLUSIONS While the addition of low dose chlorpromazine and promethazine to standard of care for acute ischemic stroke did not have any significant improvement in functional outcomes, there were no serious adverse effects. Thus, the use of chlorpromazine and promethazine in the acute ischemic stroke setting and future studies using higher doses of C+P are justified.